Frequently Asked Questions

Dermatitis is the inflammation of the skin. Occupational contact dermatitis is caused by substances at the workplace that come into contact with the skin and give rise to irritation or allergy. It is a very common cause of occupational diseases, but there are many precautions you can take to avoid this condition.

Three forms of dermatitis are:

• contact urticaria (CU);
• irritant contact dermatitis (ICD) and;
• allergic contact dermatitis (ACD).

Nurses whose hands are exposed to wet work for long periods are at high risk of suffering from irritant contact dermatitis.

Regardless of substance contact dermatitis is characterised by inflammation of the skin. The symptoms are similar to sunburn. The skin may redden, turn hot, swell mildly and tiny fluid-filled blisters may form. Symptoms can also be accompanied by itching and later shrivelling (water loss) of the skin, wounds and cleavages (fissures). While irritant contact dermatitis can appear within an hour of working with a certain substance (depending on how aggressive the substance is), allergic contact dermatitis takes hours or even days to develop fully.

Allergic contact dermatitis usually develops after prolonged contact with sensitising substance during which the effectiveness of the skin barrier is decreased. Loss of water and natural oils harms the skin and allows sensitising agents to penetrate it. The substances can link to the cells of the immune system and reach any part of the body. Repeated contact causes the immune system to develop a ‘memory’ of the substance. This memory is activated the next time the skin comes into contact with the substance concerned and presents an inflammatory reaction with itching eczema.

Always use the right gloves, and use them appropriately. Use gloves for wet work, such as bathing patients and washing. Use gloves only as long as you have to and take them off as soon as they are not needed. Wash hands after using latex gloves to prevent latex allergy and use moisturiser on hands. Prolonged use of gloves results in maceration of the skin. This breaches the skin’s outer barrier and allows all kinds of material to invade the inner layers. Repeated hand washing can also damage the skin by desiccating it (drying it out).

If there is no visible dirt on the hand alcohol-based disinfectant hand rubs should be used rather than washing with water. Moisturise (re-hydrate) your skin with approved skin care products regularly at work and at home.
Jewellery can contain metals that may be dissolved by sweat and cause allergy (e.g. nickel, chromium). Rings can trap sensitising agents underneath and the prolonged contact increases the risk of allergy. Wearing jewellery at work poses an accident risk as well.
If allergy is proved, elimination of contact is required. This can be done by using appropriate gloves.

Burnout is defined as a syndrome of emotional fatigue, alienation and reduced abilities. It is a serious condition in which people suffer from a negative change in feelings, attitude and expectations. This is often followed by severe problems at the workplace as well as in the private context. Affected persons experience fatigue, tiredness and reduced work abilities. For people working in the health care sector symptoms can manifest in terms of alienation from the patient, lack of emotions and empathy, and cynicism or aggression against the patient.

Burnout is often caused by an interaction of external (job-related) and internal (individual-related) factors:

• External factors include workload, work organisation and personal situation at work:

  • work that requires permanent concentration and devotion to a patient, who has to be handled gently at the same time, often leads to mental overload;

  • time pressure is a relevant factor, as it places limits on patient-oriented care and creates the impression that the health care worker is not caring enough;

  • monotonous work, lack of autonomy in decision-making, unpredictable situations and restricted work may be further factors;

  • unclear job descriptions, undefined responsibilities, bad flow of information, lack of recognition at work and being underpaid – all these factors can strengthen tendencies towards burnout.

• Internal factors that can lead to burnout are:

  • personal attitude to the work, especially a strong professional ethos or the so-called ‘helper’ syndrome;

  • personal skills, especially a poor problem-solving ability;

  • enthusiasm for the job, high personal ambition and deficiencies in maintaining a personal psychic balance;

  • with regard to care workers this means that on the one hand emotional qualities such as empathy and compassion are highly necessary when working in the health care sector. On the other hand, these same qualities can intensify emotional stress and potentially lead to burnout.

The measures of prevention and intervention can tackle both external and internal factors. They are, therefore, known as organisation-based and behaviour-based measures respectively.

Examples of organisation-based measures are:

• A positive work culture – feedback, appreciation and a respectful interaction at work are essential resources for the well-being of workers;

• A clear and well-defined job description, responsibilities and expectations;

• Taking care of a limited number of patients in all aspects of the necessary care is preferable to carrying out single tasks such as measuring the blood pressure of all patients;

• Realistic time planning and nurse-to-patient ratio;

• Providing possibilities for support (e.g. by superior) in difficult situations;

• Possibilities to reward good performance, giving feedback;

• Support open communication and information at work;

• Talk with the workers about their expectations and professional goals;

• Frequent team meetings and case reviews support the information exchange and help reduce conflicts between colleagues;

• Establish a health circle. It can be used to identify problems and to reduce strain at work. Medical staff can talk about it and as experts plan actions for their own health and well-being (participation and empowerment);

• Let the workers participate in the planning of the duty roster. Flexibility can help to reduce potential stressors;

• A flexible work design also helps to reduce the peaks at work. For example, not every patient prefers dealing with personal hygiene early in the morning. Try to distribute tasks over the day.

Examples of the behaviour-based measures are:

• Learn to accept the limitations of the job. Do not take on the patient’s problems as if they were your own;

• Evaluate your expectations regarding your work. Unrealistic goals and expectations can lead to frustration, potentially the beginning of burnout;

• Medical staff often have a high degree of idealism and a high level of engagement, which is a good thing. However, try not to feel too frustrated when your professional goals are not always met;

• Share emotional strains with colleagues, family and friends or ask for professional help;

• Ask for help in difficult situations;

• Do not take your work problems home; try to establish a good work-life balance;

• Vocational training on topics such as stress management, communication and conflict management can provide new ideas on how to cope with problems;

• Take breaks at work. A few minutes for recovery can make quite a difference.

Unfortunately, burnout is often considered primarily as a personal problem. Therefore, behaviour-based measures are more frequently taken into account. However, they address only some of the possible factors behind the burnout. Hence, it is strongly recommended that organisational measures are addressed in order to tackle external factors, especially as such measures are proven to be very effective and easy to implement. Furthermore, good job planning and work design can be a fertile base for additional changes in the worker’s behaviour and personal attitude.

Violence at work can be characterised as aggressive behaviour – expressed verbally, psychologically or physically – towards the worker. It can take the form of uncivil behaviour showing a lack of respect, direct verbal or physical aggression with the intention to injure, or an assault causing substantial harm.

In the health care sector violence at work often takes the form of aggressive behaviour by patients towards the health care workers. It arises from the close interpersonal relations between nurse and patient and can provoke severe mental strains and trauma among workers.

There are various reasons for violence at work. They can arise from difficult personal circumstances of patients who suffer from severe or chronic illnesses, from dementia or from disabilities. This correlates with the fact that violence is reported more frequently in intensive care, geriatric care, emergency rooms and psychiatric care.

Before an escalation, tension often builds up over a long time. For the effective prevention of violence, the reasons have to be observed and analysed. Violence can be triggered by:

• Frustration on the part of the patient, which can be caused by fixed schedules in regard to personal hygiene, meals, sleeping times, etc.;

• Anxiety about uncertain situations, about not being cured or receiving an unfavourable diagnosis;

• Contradiction of one’s own wishes, interests and perception of the situation;

• Trauma or pain after an accident or operation;

• Psychiatric factors, for example fear by the patient that they are being poisoned by the nurse;

• Disorientation after admission to hospital or transfer to a new facility;

• Fixed time schedules;

• Constraints, for example being medicated against one’s will;

• Lack of attention and dedication by the nurse caused by heavy workloads, inadequate equipment or staff shortages.

Various measures can help reduce the possibility of violent or aggressive behaviour by the patient:

• More flexibility with regard to personal hygiene, sleeping times, etc. according to the need of the patient;

• Clearly defined rules of behaviour, which help the patient to cooperate and adapt to the difficult situation;

• Allowing the patient greater privacy;

• Providing distractions and alternative activities so that patients will not focus exclusively on their suffering;

• Good organisation of post-operative care, including allowing sufficient time for questions the patient might want to ask;

• Appropriate care of patients with a high need of care such as patients with dementia and other mental illnesses;

• Reducing uncertainty on the part of the patient by providing detailed information about their condition and providing enough time to talk to the doctors;

• An adequate patient-to-nurse ratio. Realistic timetabling helps avoid work overload and allows the nurses to give proper attention to the patients.

Strategies can be learned to deal with violent patients in a professional way:

• The worker should try not to take insults personally as this will only inflame the situation;

• If aggressive behaviour is observed, the worker should inform colleagues, management and the medical service in order to get support and further advice;

• All workers should keep a safe distance from the violent patient so that the patient does not feel cornered;

• The nurse who has the closest relationship with the patient should try to calm them and to de-escalate the conflict;

• Violent patients should be confronted about their misbehaviour at a calm moment to show them that violence will not be tolerated;

• Violence should be tackled as soon as possible. Specially trained personnel should support the nurses in order to prevent them incurring long-term physical and mental harm

See also:

• European Agency for Safety and Health at Work (EU-OSHA, 2002): Fact Sheet 24 – Violence at Work. Bilbao 2002. Available at: http://osha.europa.eu/publications/factsheets/24/index.htm?set_language=en

Employers used to focus solely on the prevention of occupational diseases and work accidents, but nowadays general health promotion is becoming more common as employers benefit from the health and well-being of skilled and experienced workers.

WHP programmes can include:

• Medical screening tests at the workplace (e.g. early detection of high blood pressure, diabetes, cancers etc.);

• Support for healthy eating and physical activities, including back exercises;

• Smoking cessation and alcohol/drug abuse prevention activities;

• Actions focusing on mental health promotion.

Active tobacco smoking is the most widespread ‘voluntary’ health damaging factor. It is proven that besides lung cancer smoking can contribute to the development of severe diseases such as occlusion of blood vessels resulting in heart attack, stroke or smoker’s leg, which can result in amputation. Chronic bronchitis and cancers in the mouth, throat or kidneys can also be caused by smoking. However, within just one minute of quitting the body can start to regenerate. You will feel better in days and the health risk fades away in years.

Alcohol consumption beyond recommended measures is also a risk factor. Drinking alcohol should be reduced as far as possible and never be done at work or before driving. Even small amounts of alcohol will increase the risk of accidents at work and in traffic significantly. One glass of wine or a beer after work is usually harmless for most of us. But you should take into account that heavy drinkers have shorter lives than other people. The primary target organ of alcohol is the liver, but it also increases blood pressure, damages cells in the heart and in the brain. Frequent abuse of alcohol will also raise the chance of getting cancer.

The fundamentals of healthy living are healthy eating and regular physical exercise. An unhealthy diet undermines the defence system of the body as well as capacity for work. Overeating results in obesity, which is the cause of many diseases such as diabetes, high blood pressure and joint pain. The following general rules can help ensure a healthy diet:

• Regular eating – always have breakfast, a hot main meal and not too much food before bedtime;

• Devote mealtimes to eating and do not eat while working;

• Enjoy a variety of foods (balance of proteins, carbohydrates, fats, vitamins and minerals);

• Have less sugar and more fruits and vegetables;

• The recommended daily intake of different food groups is represented in the so-called food pyramid.

In the same way that an unused bolt easily gets rusty, the human body can develop disease unless it is exercised regularly. Even small actions can have a big contribution to the well-being:

• Climb the stairs rather than using the lift;

• Go to work by bicycle;

• Get off the bus one stop before your usual stop to make yourself walk more;

• Try to engage in outdoor work and sports in your leisure time. Though your work may be physically tiring, it is no substitute for leisure-time sports activities that help to remove work stresses and strains from the body;

• Back pains related to augmented load on the spine in health care can be prevented by special exercises that strengthen and stretch the back.

Working in the health care sector can take a heavy toll both physically and mentally. To avoid burnout you need to achieve a work-life balance. Work-life balance is the state when issues at work do not have a bad influence on private life and things at home do not create worries or problems at work. Stress at work, work overload and taking work home can throw the work-life balance out of kilter. Problems at home, e.g. with child care, care for elderly relatives, tensions in the relationship with a partner, can have the same effect.

The result is fatigue, absenteeism and loss of productivity. Employers can improve this situation by putting in place appropriate work-life policies, such as providing child care facilities or allowing flexible working hours. Everyone needs to devote time to themselves and find ways of relaxing and restoring energy. Sport, cultural and other leisure activities are also ways to maintain your work ability. If you encounter shocking life events frequently you may benefit from self-help groups where you can speak out and unburden your feelings.

Shift work can cause sleep disturbances resulting in tiredness and fatigue. Have 7-8 hours sleep daily in a calm environment. Consult a specialist if you always feel tired.

Finally

Healthy living is essential not only to ensure you give your best at work, but also to prolong your life and enhance its quality.

General preventive measures include:

• Regular disinfection of surfaces and instruments;
• Appropriate dangerous waste management;
• Good ventilation;
• Isolation of highly infectious patients;
• Isolated dressing room, eating and drinking facilities and lavatory for personnel;
• Appropriate information provision and training;
• Vaccination (if applicable);
• Use of protective clothing;
• Prohibition of eating and drinking (and smoking) at work site;
• Regular thorough hand washing.

Work should be organised in such a way that as few staff as possible are in contact with highly infectious patients.

• Inhalation: microorganisms in the air are breathed in and they invade the respiratory system. Special prevention includes appropriate ventilation, isolation of patients and use of respiratory personal protective equipment.
• Ingestion: microorganisms enter the digestive system through the mouth. Prevention includes regular washing and disinfection of hands.
• Contact: microorganisms enter the body either through a wound in the skin or when it is punctured by a sharp object (e.g. needlestick injuries), or through mucous membranes. Basic prevention is use of gloves and control of sharp objects. Gloves also prevent the accidental penetration of blood via the microscopic wounds found on any normal skin. If squirting of blood or body fluids is likely, masks with eye protection are recommended.

Hepatitis viruses

• Hepatitis viruses are given the label A, B or C. Hepatitis A (HAV) causes an acute hepatitis usually accompanied by jaundice. HAV does not turn into a chronic disease, nor does it cause cirrhosis or liver cancer. The most important way the virus is spread to the environment is via the stools. Therefore, the standard hygienic regulations (washing and disinfecting hands, using gloves, careful handling of contaminated linen) helps to avoid infection. Vaccination against HAV is recommended for employees working with patients at high risk for HAV.
• Hepatitis B (HBV) initially causes mild symptoms and it may not be accompanied by jaundice; hence it may go unnoticed. The significance of HBV infection is that it may give rise to a chronic disease leading to hepatic cirrhosis and liver cancer over a period of years. HBV infection comes from blood, bodily fluids or tissues and infects via contact transmission. HBV is very resistant and can survive on surfaces for a week, remaining infectious even if the bloodstain is not visible. Prevention of HBV infection includes control of blood and bodily fluids and contaminated objects, control of sharp objects and immunisation of personnel. After vaccination a check of immunisation level is recommended. In positive cases lifetime immunity is expected.
• Hepatitis C (HCV) also causes mild symptoms but has the potential to cause cirrhosis and liver cancer. HCV has similar transmission features to HBV and can survive at room temperature for days. There is no vaccination against HCV, so prevention is limited to the control of blood and bodily fluids and contaminated objects, together with control of sharp objects.

Human Immunodeficiency Virus (HIV)

• The virus causing AIDS (acquired immunodeficiency syndrome) has a long incubation period with few or no symptoms. In health care work HIV can be transmitted through contact with infected blood or bodily fluids (e.g. needlestick or sharps injury). There is no vaccine against HIV, so prevention is limited to control of blood and bodily fluids and contaminated objects, together with proper management of sharp objects.

Influenza and other respiratory viruses

• Influenza is just one of the thousands of viral agents that cause upper and lower respiratory tract infections with cough and fever. Inhalation of microorganisms is followed by the symptoms in days. Influenza is usually accompanied by muscle pain and if bed-rest is not taken it can progress to pneumonia. Influenza tends to appear in mass outbreaks causing epidemics from autumn to spring. Prevention includes proper ventilation of wards, control of excreta and contaminated objects, washing of hands and use of personal protective equipment. Annual vaccination against the latest type of influenza helps to avoid or ameliorate infection and is recommended for health care workers caring for patients at high risk of contracting influenza.

Calicivirus (also known as Noroviruses or Norwalk-like viruses)

• Calicivirus causes infective enteritis presenting as vomiting, diarrhoea and sometimes fever. It is a highly infective virus (even 10 can cause disease) found in the excreta of patients and is spread by ingestion and inhalation. Only very strict quarantine rules can stop epidemics in care institutions. Besides strict hygienic provisions, contaminated objects must be disinfected.

Tuberculosis

• Tuberculosis is caused by mycobacteria, which are very resistant air-borne pathogens. They are spread through coughing and from sputum from the infected patient and can survive for months. Following the inhalation of microorganisms, it takes weeks to develop the first symptoms (coughing, fever). Prevention includes the isolation of the patient, proper ventilation of wards, control of excreta and contaminated objects and the use of personal protective equipment. Vaccination is available in some countries, but there is no clear evidence on its effectiveness.

Pyogenic bacteria

• Several strands of bacteria can cause pyogenic skin lesions in wounds. Following direct contact, inflammation, localised pus and/or reddening of the skin develops. Recommended prevention measures are disinfecting hands, covering wounds and the use of gloves. Many bacteria reside on the skin of otherwise healthy individuals. Drug-resistant variants (MRSA: methicillin-resistant Staphylococcus Aureus) pose an extreme risk to certain patients, so cases are quarantined in order to prevent spread to other wards.

Scabies

• Scabies is a reaction to tiny insects penetrating the skin and causing itching, most typically at the wrists and elbows. The unavoidable scratching causes wounds that allow dangerous microorganisms to breach the skin. Transmission is through direct contact with infected patients or their clothes. Infection can occur even when good personal hygiene is observed, and crusted scabies is highly infective. Isolation of the patient, elimination of direct skin contact by wearing gloves, aprons and long-sleeved clothes may prevent infection. Some suggest preventive medical treatment for every person who has been in contact with a patient with crusted scabies. Linen used by infected patients must be kept in plastic bags and disinfected at laundry.

See also:
 

European Agency for Safety and Health at Work, Expert forecast on Emerging Biological Risks related to Occupational Safety and Health (2007). ISBN 92-9191-130-5. Available at: http://osha.europa.eu/en/publications/reports/7606488/view
 

Harassment (also described as ‘bullying’ and ‘mobbing’) can be described in general terms as aggressive or hostile interaction at the workplace. It is one of the most extreme psychosocial strains that can occur in the work environment. According to Leymann (1993), bullying is a form of communication burdened with conflict at the workplace. It can happen between colleagues of the same rank as well as between supervisor and supervised person. One person is considered to be inferior and is attacked directly or subtly by one or several others in a systematic way and often over a considerable period of time with the objective of excluding them or discriminating against them on the job. The harassed person experiences the aggression as discrimination or exclusion.

The European Agency uses with the following definition of harassment (EU-OSHA, 2002): ‘Workplace harassment is repeated, unreasonable behaviour directed towards an employee, or group of employees that creates a risk to health and safety’. Within this definition:

• ‘unreasonable behaviour’ means behaviour that a reasonable person, having regard to all the circumstances, would expect to victimise, humiliate, undermine or threaten;

• ‘behaviour’ includes actions of individuals or a group. A system of work may be used as a means of victimising, humiliating, undermining or threatening;

• ‘risk to health and safety’ includes risk to the mental or physical health of the employee.

Harassment often involves a misuse or abuse of power where the targets can experience difficulties in defending themselves.

Most commonly harassment arises from an unsolved or badly managed conflict at work. Deeper reasons can lie in environmental circumstances on the job, stress, tight deadlines, a tight labour market, poor communication or poor managerial skills. These factors can turn an argument about business matters into a personal struggle. The conflict will be displaced on to the victim, who will be attacked and forced into the position of outsider.

A German survey on bullying estimated that the social sector, including geriatric and family nurses, was the sector with the highest risk of harassment. The risk to health care workers is also above average.

These results correlate with the fact that stress and heavy workloads are typical for working in the health care sector. Further factors are frustration from the feeling of not being respected (especially in very hierarchical environments) or from an imbalance between workload and payment (caused by cost reduction measures in health care sector: lay-off of personnel, reduction of salaries) .

Despite common stereotypes victims of bullying do not appear to have a ‘typical’ personality. But generally speaking, a high social competence and good conflict-solving abilities help to break through or to stop the harassment process in an early stage.

Common symptoms of harassment are:

• Excluding the victim from communication;

• Hindering the work flow;

• Humiliation;

• Unjustified accusations or spreading rumours.

The situation escalates when the victim feels distressed by the permanent attacks. Harassment may even lead to a point where the harassed person is considered to be a problematic employee and threatened by disciplinary consequences, including the loss of the job.

Harassment has severe psychological consequences for the victim, who often is not able to work any longer in the job. More than 40% of victims fall ill because of harassment, nearly half of them for six weeks or longer. In many cases, harassment can only be overcome by the victim leaving the job or transferring elsewhere in the organisation. In most cases it is the victim who initiates the necessary changes, but sometimes the employer considers that laying off the harassed person is the easiest way to put an end to the harassment.

Harassment also constitutes a financial burden for the employer (e.g. work absences, new recruiting and probably a reduction in productivity due to the conflict), the worker who may suffer from unemployment or have to retire prematurely, and to the statutory and health insurance institution through rehabilitation measures, elevated pension costs, etc.

As harassment is causing serious consequences, effective preventive measures need to be introduced. Measures should take into account the factors that contribute to an increased risk of harassment.

• With regard to the work environment, possible measures could include:

  • Carrying out a risk assessment in order to identify and eliminate stressors, e.g. with the help of health circles;

  • Amending work organisation or work flow in order to reduce the staff workload;

  • Realistic time planning;

  • Adapting the nurse-to-patient-ratio to the actual demands;

  • Providing clear and transparent decisions to avoid misunderstandings and unclear situations at work.

• Concerning person-related factors:

  • Enhancing internal communication between the workers, and between the workers and management;

  • Taking the workers and their problems and suggestions seriously;

  • Improving problem-solving abilities in vocational training with regard to the particular tasks and the social conflicts at work;

  • Promoting workplace health to enhance the work/life balance of the workers;

  • Training in social skills and management skills for workers and management respectively.

See also:

• European Agency for Safety and Health at the Workplace (2002): Facts 23. Bullying at work. Bilbao 2002. Available at: http://osha.europa.eu/publications/factsheets/23.

• European Agency for Safety and Health at Work. Resources on stress and psychosocial risks are available at: http://osha.europa.eu/en/topics/stress

The European Agency for Safety and Health at Work does not cover the development or distribution of standards for products or equipment or their testing. Below are some suggestions for possible avenues to obtain further information.

Information regarding occupational safety and health and equipment used in healthcare can be found on the Agency health care web feature at:
http://osha.europa.eu/good_practice/sector/healthcare/index_topic?topicpath=/good_practice/sector/healthcare/safety_buildings_equipment

Information regarding safer needle devices can be found on the Agency health care web feature at:
http://osha.europa.eu/good_practice/sector/healthcare/index_topic?topicpath=/good_practice/sector/healthcare/biol_hazards and http://osha.europa.eu/good_practice/sector/healthcare/index_topic?topicpath=/good_practice/sector/healthcare/biol_hazards_needle

Information about standards organisations and standard setting in the European Union can be accessed from the Agency website at:
http://osha.europa.eu/legislation/standards/

Useful information about standardisation is given on the European Commission DG Enterprise website at: http://europa.eu.int/comm/enterprise/faq/en/standardisation_en.htm

Information about risk assessment of products and devices can be found on the European Commission website at: http://europe.eu.int/comm/health/ph_risk/risk_en.htm

European Commission – DG Enterprise
http://europa.eu.int/comm/enterprise/index_en.htm
The Commission's Directorate General Enterprise provides information about medical devices, including links to relevant legislation at: http://europa.eu.int/comm/enterprise/faq/en/medical_devices_en.htm

EU Scientific Committee on Medicinal Products and Medical Devices:
http://europe.eu.int/comm/health/ph_risk/committees/scmp/scmp_en.htm

European Commission – DG Enterprise, Pharmaceutical and Cosmetics website:
The Commission's Directorate General Enterprise includes a unit responsible for pharmaceuticals and cosmetics. http://dg3.eudra.org/

The European Agency for the Evaluation of Medicinal Products (EMEA) co-ordinates and supports the EC licensing system for medicinal products.
http://www.emea.eu.int/

Heads of Agencies is the common Website for the medicines authorities in the European Union
http://heads.medagencies.org/

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The European Agency for Safety and Health at Work only deals with occupational health issues. Enquiries about public health or patient treatment and wellbeing are outside of our remit. Below are some suggestions for possible avenues to obtain further information.

Public health issues in the European Union are covered by the European Commission Directorate General Health and Consumer Protection. Information about European Union public health programmes can be found on their web pages at: http://europe.eu.int/comm/health/index_en.html
This site can be read in all European Union official languages.

The European Commission provides information about European Union activities on public health at: http://europe.eu.int/pol/health/index_en.htm

HOPE is a nongovernmental European Association and includes national hospital associations as well as representatives from the national health systems of the 15 member states of the EU. Details of their publications are available at their web site, which include general information on health care systems and social dialogue in the sector in the European Union.
HOPE the Standing Committee of Hospitals of the European Union http://www.hope.be/

Many Ministries for Health in the various Member States of the E.U. will have a web page giving information about their health care systems and programmes.

Many nongovernmental organisations and research institutes in the Member States will provide information about health programmes and policy in their Member State.

For example:
Ecole nationale de santé publique: http://www.ensp.fr/

This site provides a good source of information in general about the French health care service, however a password is needed to use the documentation service.

The World Health Organisation provides worldwide information on public health: http://www.who.int/

The most significant physical risk in health care is ionising radiation in the form of X-rays and radioisotopes. Risk from these sources has been reduced considerably because of strict regulations, engineering of modern technology and the use of personal protective equipment.

Laser, ultraviolet light and electromagnetic fields are far less common physical risks.

The most dangerous chemical risk factors in health care are drugs used in the treatment of cancer. Most of these so-called chemotherapy drugs are able to induce cancer or damage reproduction, thus there is no safe value for them. Workers are exposed to these substances through skin contact or inhalation. The most high-risk activity in this regard is the preparation of chemotherapy drug solutions, a process that must be carried out in isolated conditions. Administration of these solutions and work with patient excreta and contaminated linen also calls for adherence to safety instructions such as the use of gloves and aprons.

Milder chemical risks include disinfectants and cleaning substances that can cause skin diseases. Gloves contain latex, which can be a source of allergy.

Apart from the risks of caring for patients with acute infectious diseases the most important biological risks are viruses causing hepatitis and AIDS (acquired immunodeficiency syndrome). The latter diseases are associated with invasive (‘bloody’) interventions.

Physical work affecting the muscles, joints and bones, and especially the lower back, is associated mainly with patient handling. Nurses and paramedics are at the highest risk of developing musculoskeletal disorders (MSDs). Adverse ambient conditions can pose a risk in the case of heavy work and high temperatures, e.g. in operating theatres.

The unpredictability of events, everyday tragedies, night shifts, the stressful work of an emergency unit, aggressive behaviour by patients, violence from frustrated relatives and working abroad are the most common psychosocial risk factors. These circumstances can place a heavy burden on health care workers and give rise to psychological problems (e.g. stress, burnout) or psychosomatic disorders. Among those particularly vulnerable to mental stress are care workers in wards with few successful outcomes (e.g. social care for the severely disabled, oncology ward) or where tragedies happen frequently (e.g. emergency department).

Prevention of most occupational diseases caused by these risks is possible provided the employer fulfils its duty by ensuring a safe work environment, and the worker follows safety and health regulations.

See also:
 

European Agency for Safety and Health at the Workplace (ed): Factsheet 29: Safety and health good practice online for the health care sector. ISSN 1681-2123. Available at: http://osha.europa.eu/en/publications/factsheets/29/view

All Member States' homepages have a section dedicated to legislation. Some of these give direct access to national legislation texts in the area of health and safety at work. However, due mostly to problems with interpretation, these are generally only available in the national language.

In principle, the Agency as such does not dispose of the necessary resources to give financial support to external projects. From time to time, however, the Agency is commissioned by the European Union to administer and implement specific funding activities that are directly related to improving safety and health at work, e.g. the European Week or the SME accident prevention scheme. You can find information about such schemes at http://sme.osha.europa.eu/
A general overview on grants and loans provided by the European Union is given on the website of the Secretariat General of the European Commission (http://europa.eu.int/comm/secretariat_general/sgc/aides/index_en.htm).
If your project relates to health and safety at a national level, we recommend that you approach your national Focal Point.

Much of the information appearing on the Member States' web pages is collected through the national network in that country or provided via links. Therefore, it is impractical to translate all of this information into the other European Union languages. Nevertheless, most Member States provide some information in English.

As set out in its founding regulation (2062/94 and 1643/95), the Agency cannot give advice on individual health and safety situations. You can find out which organisation in your country is competent to give you this information from your national Focal Point, or directly from the national website under the section 'Systems'.

The full text of European legislation covering health and safety at work is available on this website in all Union languages. Further information and other legislation can be found at the Commission's Eur-Lex website or you can subscribe to the more comprehensive Commission site on legislation called CELEX.

As with all Agency publications, the information reports are posted on this website in several languages as soon as they are published and can be viewed on-line and downloaded free of charge. All Agency publications are printed in a limited number only. If you wish to receive the printed version, you should contact your national Focal Point.

All Member States' homepages have a section dedicated to statistics. Some of these give access to national figures about accidents at work and occupational diseases and related costs. Due mostly to interpretation issues, these are generally only available in the national language. The Statistics section of this website gives European level information from various organisations.